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Child heart surgeons access clearer picture of their success rate

For the
first time, teams that care for children needing heart surgery have been able
to review their short-term success rate better across all the different
operations they perform.

Graphic
data charts, devised by analysts at UCL, now allow child heart surgeons to spot
and investigate trends in survival and act promptly on any concerns.

Published
today in the journal Heart, a new
paper describes how charts showing survivals to, and deaths within, 30 days of
surgery are being generated and studied by teams at Great
Ormond Street
Hospital, Evelina Children’s Hospital
and the Royal Hospital
for Sick Children in Glasgow.

The study
follows recent controversy around comparisons of deaths rates following
surgery.

Importantly,
the charts account for very different levels of risk faced by different
children - from under one percent risk of death to more than 25% - and help
hospital teams spot any underlying trends. The risk estimates come from
peer-reviewed work by the same team published last year using UK national data.

Dr
Christina Pagel, lead author of the paper from the UCL Clinical Operational
Research Unit, said: “The software tool that we’ve developed provides teams
with a way of routinely monitoring their own risk-adjusted results, which
they’ve not been able to do previously because of the complexity and diversity
of their work.”

The software tool that we’ve developed provides teams with a way of routinely monitoring their own risk-adjusted results, which they’ve not been able to do previously because of the complexity and diversity of their work.

Dr Christina Pagel

She added:
“This is important because it means that the teams can learn from their recent
outcomes and respond quickly where necessary. By working closely with the
surgical teams, we could explain the limitations of the risk-adjustment, which
is never perfect, as well as the strengths.”

The data
presented in the paper captures all procedures performed in 2010 and 2011. All
three centres got useful insights from looking at their outcomes in this way.

Dr Pagel
said: “Our work is about facilitating improvement rather than comparisons
between centres. Comparisons between centres remain challenging - for instance,
some centres treat a higher number of very premature babies and this isn’t
accounted for in our risk-adjustment because those data were, historically, not
routinely submitted to national audit.

“This sort
of additional information is, of course, available to the clinical teams, who
are able to put the risk-adjusted results into context. That’s why we think
that these charts are most useful at a local level. I’m glad that each centre is
still using the prototype software and there are plans in place to roll-out the
tool nationally.”

More information

Sir Bruce
Keogh, Medical Director of the NHS, who has previously called for all NHS
trusts to publish surgical outcome data, said: “This is a great example of
constructive collaboration between academics and clinicians to give clinical
teams that the tools they need for quality assurance and to further improve
outcomes.”

Stephen
Thornton, Chief Executive of the Health Foundation, which part funded the
study, said “We are delighted to have supported such an innovative piece of
research and hope the tools produced from this project will have a wide appeal
across the paediatric heart surgery network.”